Provider Demographics
NPI:1598097651
Name:LOPEZ, CARLOS JESUS (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JESUS
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 W SUNSET BLVD
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6082
Mailing Address - Country:US
Mailing Address - Phone:323-783-2600
Mailing Address - Fax:
Practice Address - Street 1:4700 W SUNSET BLVD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6082
Practice Address - Country:US
Practice Address - Phone:323-783-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-31
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical